Provider Demographics
NPI:1497885719
Name:LOUIS A FRAGOLA JR MD LTD
Entity Type:Organization
Organization Name:LOUIS A FRAGOLA JR MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRAGOLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:401-433-4851
Mailing Address - Street 1:1525 WAMPANOAG TRAIL
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-433-4851
Mailing Address - Fax:401-433-3650
Practice Address - Street 1:1525 WAMPANOAG TRAIL
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-433-4851
Practice Address - Fax:401-433-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI4166207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000529Medicaid
RI000823OtherBLUE CHIP
RI5292OtherBLUE CROSS
C90436Medicare UPIN